Title: Factors influencing 25-year survival in pediatric liver transplant recipients
Source: Pediatric Transplantation 2025, 29 (7): e70189
Date of publication: October 2025
Publication type: Retrospective analysis
Abstract: Background: This study assesses the impact of cholestatic liver disease, including biliary atresia, on 25-year survival post-transplantation and additional factors influencing long-term outcomes after pediatric liver transplantation.
Methods: We conducted a retrospective analysis of pediatric liver transplant recipients (1987-1998) using de-identified data from the OPTN 2023 Liver Database. After exclusions for multi-organ transplants (n = 222), prior transplants (n = 2256), and deaths within 1 year (n = 526), 2429 patients remained, including 645 with cholestatic disease. Univariate and multivariate analyses identified factors associated with 25-year survival.
Results: A primary diagnosis of cholestatic disease was associated with improved 25-year survival (OR: 0.67, p = 0.023). UNOS regions 2 (OR: 0.65, p = 0.009) and 5 were also associated with improved survival (OR: 0.72, p = 0.044). Decreased survival was associated with recipient ages 8-12 (OR: 1.84, p = 0.009) and 12-18 (OR: 2.90, p = 0.003), donor age ≥ 19 (OR: 1.42, p = 0.021), African-American (OR: 1.94, p = 0.000) and other minority recipient ethnicities (OR: 2.49, p = 0.018), donor bilirubin ≥ 2 mg/dL (OR: 1.85, p = 0.022), and UNOS region 10 (OR: 1.62, p = 0.009).
Conclusion: This study evaluates 25-year survival in pediatric liver transplant recipients while analyzing the protective influence of a cholestatic disease diagnosis. Older recipient and donor ages, minority recipient ethnicities, elevated donor bilirubin, and specific UNOS regions are associated with decreased 25-year survival. Further research is needed to address outcome inequalities.
